Legal Full Name (first and last) *
Legal Full Name (first and last)
Address *
Address
Phone *
Phone
Please provide any DBA's or assumed names here as well.
Example: LLC, C-Corp, S-Corp, Sole Prop, etc.
Please provide all services you plan to offer while treating at Modrn.
reference can be prior employer, previous spa or wellness landlord, colleague you have worked with. We do not accept friends or family as references. if you are just out of school, please provide the name of a teacher or administrator at your school.
I confirm I have answer the above questions honestly and to the best of my knowledge. *